​With just 3 weeks’ notice, SGH brought the COVID-19 vaccine to our staff and kick-started a nationwide vaccination.

From the time it was announced that a first COVID-19 vaccine was approved for use in Singapore, it took just 3 weeks for SGH and SingHealth to launch the start of the nation-wide vaccination on 8 January 2021 by inoculating our Prime Minister and staff. Healthcare workers were among the first to be vaccinated given the exposure to COVID-19 inherent in our work.

Getting the Pfizer-BioNTech COVID-19 vaccine into arms in that short a time was no easy feat. It involved complex logistics and careful and detailed planning of work processes to ensure the safety of all staff being vaccinated. As vaccination was voluntary, staff were provided with the latest information to help them decide whether to receive the vaccine.

Capacity

SGH runs the biggest vaccination operation for staff in SingHealth, catering also to those from the National Dental Centre Singapore, National Neuroscience Institute in SGH, SingHealth Headquarters and the Singapore National Eye Centre. We also take care of staff of our service partners who work on our premises in areas such as housekeeping, security and IT. 

Leading the operation were Senior Consultants Dr Limin Wijaya from Infectious Diseases and Dr Lim John Wah from Occupational & Environmental Medicine, with doctors from their departments.

Nurses were deployed from the Travel Clinic, wards as well as ambulatory areas of SGH to administer the vaccinations. “We deployed 11 nurses, of which one is a Nurse Clinician, for this operation. We started with 6 nurses and had 5 on standby for ramp up, especially when we start vaccinating staff with their 2nd dose as well,” said Deputy Director Nursing, Elena binte Mohamed Ayob.

Ready to go!

Completing the team at the Vaccination Centre at Deck on 9 are colleagues from various Divisions who took care of administrative processes, data collation and safe distancing measures, led by the team from Preparedness & Response (PRD).

“We had only 3 weeks to start operations, and subsequently ramped up to more than double the capacity within 2 weeks.” said Jorin Ng, Senior Manager of PRD.

Dr Lim John Wah (in scrubs) with PRD team at admin briefing 

Transportation, storage and handling

Every morning, our Travel Clinic orders the vaccine based on the number of staff scheduled for vaccination two days later. The vendor, who stores the Pfizer vaccine in its warehouse at minus 70 degree celsius, thaws them before transporting them to SGH in validated foam boxes packed with coolant the next day. Once thawed, the vaccine cannot be refrozen but has to be kept at 2 to 8 degree Celsius for up to 5 days.

With the professional support from our vendors and procurement partner ALPS, we were able to quickly work out solutions for storage and processes to ensure timely supply to meet each day’s need.
 

Frozen vials of vaccine

Infection control and safety

An expert medical and nursing team came together to develop safe and efficient work processes, from screening to preparation and giving of the injection, as well as the observation for adverse effects after the vaccination. 
 

Patient Safety team walkabout at the Vaccination Centre

The vaccines come in multi-dose vials and have to be diluted with saline before they can be administered. Infection Prevention & Epidemiology conducted training on preventing cross-contamination with the use of multi-dose vials.

“All the doctors and nurses are given training in understanding the data on indications, efficacy, side effects of the Pfizer-BioNTech vaccine. They also attended refresher training on the preparation and safe administration of multi-dose vaccines, and were then given hands-on practice as well as competency check,” said Dr Limin.

“We had regular huddles with both the SingHealth Vaccination Operation Group as well as amongst ourselves in order to improve processes with safety of our staff as primary considerations,” she added.
 

Do you know the vaccine? Dr Limin (left) at training.

To minimise risk of errors, the processes of vaccine dilution and vaccine administration are segregated and undertaken by different staff members dedicated to the respective tasks. After dilution, the vaccine vial will be labelled with the date and time of dilution. It will then be handed over to the staff member responsible for vaccine administration. Both staff – the one handing over and the one receiving – then check and confirm before the reconstituted vaccine is accepted for use for vaccination.

All vaccinations administered are carefully documented. The number of vaccinated persons will be tallied and reconciled against the number of utilised vaccine vials to ensure that every dose in each vial is properly accounted for.

“To prevent errors that might occur from distractions, our nurse who is assigned as the dilutor for the day wears a medication vest to signal that she is not to be disturbed. We also set aside an area dedicated to this task,” said DDN Elena.

Nurse in medication vest diluting the vaccine.

Triage and managing adverse reactions

When staff arrive for vaccination, they are first screened by doctors or nurses to check if they have any contraindications to this vaccine.

“There are nuances with some of the medical conditions which require us to discuss with the staff on the risk and benefits of the vaccine,” said Dr Lim John Wah.

Another safety precaution is to observe staff for 30 minutes after vaccination, in case anyone feels unwell. We also have emergency equipment on standby in case staff feels unwell or reports severe allergic reactions.

“We engage our allergist, the pharmacists, the code blue team and the SMART team to better prepare the nursing and medical team to manage possible side effects and any anaphylactic reaction from the vaccination,” said DDN Elena.

Resuscitation drill

Making every dose count

Globally, the vaccine is in short supply and our staff are privileged to be given priority to have it. While we want to ensure we have enough stock each day, it is equally important not to waste any dose. To try to match the demand to supply for the day, vaccination is by appointment only. However, sometimes staff do not turn up, and the team has to activate colleagues who are on a standby list, to use up the dose that has been diluted and prepared.

“At the end of each day, we have to account for every single dose and match the number against the quantity delivered and prepared and the staff vaccinated. Ensuring accurate data has become our biggest challenge, as a fair bit of the data entry is done manually. When the numbers do not tally, we have to count all over again,” said Ong Jie Yi, Senior Manager of PRD.

“In many countries, even developed ones, people are desperately waiting for vaccines. In Singapore, we healthcare workers are very privileged to be assured of the vaccine if we want them, in this first phase where we are placed at the head of the queue. Ensuring health care workers’ safety from COVID-19 infection also translate to patients’ safety, as vaccination can reduce the risk of transmission to patients we look after,” said Dr Lim John Wah. 

“What do we hope to achieve? We are doing our best to make certain every single one of us get through the pandemic safely. Staff safety is our priority. It would be a sad day if any of our colleague were to fall to COVID-19,” said Dr Limin.